=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518284702
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STURGES CHIROPRACTIC HEALTH CENTER PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/27/2010
-----------------------------------------------------
Last Update Date | 04/27/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1575 KISKER RD
-----------------------------------------------------
City | SAINT CHARLES
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63304-0608
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-922-4140
-----------------------------------------------------
Fax | 636-922-4113
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1575 KISKER RD
-----------------------------------------------------
City | SAINT CHARLES
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63304-0608
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-922-4140
-----------------------------------------------------
Fax | 636-922-4113
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JOSEPH ROBERT STURGES
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 636-922-4140
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NS0005X
-----------------------------------------------------
Taxonomy Name | Sports Physician Chiropractor
-----------------------------------------------------
License Number | 2001002838
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------